Job Application

Accepted file formats: .doc, .docx, .pdf

Resume

Cover Letter

First Name

Middle Initial

Last Name

Phone Number

Email

Repeat Email

Home Address

Apt/Suite

City

State

Zip Code

Name of Position

Shift Availability

Full Time

Part Time

Permanent

Temporary

Days/Hours

Available Start Date

We want to ensure a flawless experience. If you experience any difficulty applying online, please contact us at hr@richlandhospital.com

Currently Employed Yes No

OK to Contact Employer? Yes No

Employment History

Employer 1

Job Title

Telephone Number

Street Address

City

State

Zip Code

Employment Start Date

Employment End Date

Summarize the nature of the work performed and job responsibilities

Starting Wage

Ending Wage

Reason for leaving

Name/Title of Immediate Supervisor

Employer 2

Job Title

Telephone Number

Street Address

City

State

Zip Code

Employment Start Date

Employment End Date

Summarize the nature of the work performed and job responsibilities

Starting Wage

Ending Wage

Reason for leaving

Name/Title of Immediate Supervisor

Employer 3

Job Title

Telephone Number

Street Address

City

State

Zip Code

Employment Start Date

Employment End Date

Summarize the nature of the work performed and job responsibilities

Starting Wage

Ending Wage

Reason for leaving

Name/Title of Immediate Supervisor

SKILLS AND QUALIFICATIONS: Summarize any special training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform job-related functions for the position in which you are applying

We want to ensure a flawless experience. If you experience any difficulty applying online, please contact us at hr@richlandhospital.com

Education

School Name 1

School Address

City

State

Zip Code

Years Completed

Degree Sought

Did you graduate? Yes No

School Name 2

School Address

City

State

Zip Code

Years Completed

Degree Sought

Did you graduate? Yes No

School Name 3

School Address

City

State

Zip Code

Years Completed

Degree Sought

Did you graduate? Yes No

List any additional information you would like us to consider

We want to ensure a flawless experience. If you experience any difficulty applying online, please contact us at hr@richlandhospital.com

Have you filed an application here at The Richland Hospital before?

Yes

No

If yes, please specify date:

Have you been convicted of a felony in the last seven (7) years?

Yes

No

If yes, please explain:

Are you legally eligible for employment in this country?

Yes

No

Have you ever been employed by this hospital?

Yes

No

If yes, please list position, start date, and end date:

We want to ensure a flawless experience. If you experience any difficulty applying online, please contact us at hr@richlandhospital.com

Penalties for Providing False or Misleading Information

I certify that my answers to the questions on this application are true to the best of my knowledge and I am aware that misrepresentation or omission of facts called for on this form is cause for rejection of my application or separation from the hospital service.

Reference Check Release

I voluntarily give Richland Hospital the right to investigate all references and statements to secure additional information about my past employment, education, and/or military record. I hereby release from liability of responsibility all persons, companies, or corporations supplying such information to The Richland Hospital, Inc.

Employment At Will

I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. Nothing on the application is intended to create or imply a contractual relationship. I understand that no representative of the employer has the authority to make any assurances to the contrary.

Non-Discrimination

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by ADA. The Richland Hospital, Inc. observes the right to hold and maintain this application at its discretion for future open positions. Future employment opportunities will require that a new application be completed by the applicant, unless otherwise indicated by The Richland Hospital personnel.

Background Check

If employed by The Richland Hospital, Inc. I agree to work the hours, days, and shifts as scheduled and I consent to all pre-employment health requirements required by The Richland Hospital, Inc. I also understand that any offer of employment is contingent upon Richland Hospital obtaining satisfactory responses to references inquiries, successful completion of pre-employment health requirements, and a successful caregiver background check which includes a criminal and license check.

Full Name

Today's Date

Recaptcha

We want to ensure a flawless experience. If you experience any difficulty applying online, please contact us at hr@richlandhospital.com

Thank you for applying to The Richland Hospital and Clinics.

You will receive an email shortly confirming the status of your application.